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Autism spectrum disorder (ASD) is a common and lifelong neurodevelopmental disorder with the hallmark features of social impairment and restricted and repetitive patterns of behaviour. Individuals with ASD often experience co-occurring mental health difficulties, some of which may obfuscate the ASD features themselves. Although there is a high need for mental health services for autistic adults, there are surprisingly few evidence-based treatments (EBTs) available; moreover, many mental health practitioners who are well-trained in EBTs shy away from treating autistic individuals due to lack of training in ASD.
Aims:
The aim of the current study was to evaluate the feasibility and acceptability of dialectical behaviour therapy skills training (DBT-ST) in a sample of autistic adults without intellectual disability.
Method:
Sixteen adults with ASD were recruited from a treatment waiting list to enrol in this study, which included 24 weeks of DBT-ST delivered in a group setting. Feasibility and acceptability were assessed using retention and attendance data and a participant satisfaction questionnaire.
Results:
Retention (81.3%) and attendance data (mean 87.5%) provided support for the feasibility of this intervention. Overall satisfaction ratings were high (mean 4.5 out of 5), and participants reported that they felt that DBT-ST would probably be helpful for others with ASD (mean 4.5 out of 5).
Conclusions:
The study findings provide preliminary evidence of (1) the feasibility of providing DBT-ST for autistic adults in community-based clinics, and (2) the perceived benefit of DBT-ST for this under-served population. Recommended modifications to the standard DBT-ST materials are discussed.
The coronavirus disease 2019 (COVID-19) pandemic and the necessary social isolation and distancing measures – that were adopted to prevent spreading the virus, including the suspension of university classes – negatively impacted the mental health of young adults. The aim of the current study was to investigate whether returning to online classes, even not presential, during the social isolation of the COVID-19 pandemic, affected the mental health of university students.
Methods:
Forty students (10 men and 30 women) (age, 22.3 ± 3.8 years; body mass, 62.5 ± 17.8 kg; height, 165.6 ± 8.7 cm) from undergraduate health courses participated in the study. The students answered a self-administered questionnaire designed to gather personal and quarantine information as well as information about the frequency of depression (PHQ-9) and anxiety (GAD-7) symptoms. The questionnaire was answered before and after the return to online classes.
Results:
There was a significantly lower frequency of depression symptoms after the return to online classes (Z = −2.27; p = 0.02). However, there was no difference in anxiety symptoms before and after returning to online classes (Z = −0.51; p = 0.61).
Conclusions:
Return to online classes positively impacted the mental health (decrease of frequency of depression symptoms) of university students. Future studies are needed to observe whether the changes observed after returning to school are maintained over time.
Bullying and cyberbullying are global phenomena negatively impacting on children’s and young people’s (CYP’s) mental health and wellbeing and affecting their school social experiences and learning outcomes. Many interventions and prevention approaches have been employed over the decades, most impacting differentially, with some success in certain contexts and situations but not universally, suggesting the need for more contextualised, nuanced approaches at the whole school, community, individual and peer-group levels. The recognition of the importance of student and teacher voice in recent years has heralded interest in co-design practices to deliver more context-relevant interventions and prevention strategies. This article considers how participatory design and co-design practices can form part of the prevention and intervention repertoire for schools, teachers, counsellors and psychologists in their quest to understand and reduce cyberbullying and/or bullying (C/B) behaviours. Two case-study exemplars are provided that reflect the importance of context and student-centred relevancy to inform practice.
Bullying varies in frequency, intensity, duration and hence severity, and contributes uniquely and directly to mental health problems, with severe and long-lasting consequences. Almost a half of school-age students report being bullied in the past year. All school staff, especially school counsellors, are uniquely positioned to reduce student bullying through proactive primary prevention, early intervention, and treatment. However, given the intensity of schools, and counsellors’ limited time and resources, robust evidence is needed to guide their unique contribution to a whole-school approach to reducing bullying behaviour. Since 1999, a pipeline of 18 Friendly Schools studies, including seven randomised control trials, have developed and tested ways to build all school staff’s capacity to effectively target and deliver evidence-based strategies across the prevention, early intervention and treatment continuum to reduce harm from all forms of bullying behaviour. This article describes the implications of Friendly Schools’ research findings relevant and applicable to the work of school counsellors, as part of a whole-school approach to bullying prevention. These implications demonstrate the interconnectedness of actions of all members of the school community, and the need for a whole-school commitment to preventing and reducing bullying, to realise the important synergistic contribution of school counsellors.
In light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice internationally. Various barriers that deter school psychologists and counsellors from screening have been identified, including lack of resourcing to implement screening, lack of knowledge about the mechanics of how to carry out a screening program, and concern about how to manage the anticipated increased workload generated by following up identified students. In this practice-based paper we discuss a four-stage process that guides school psychologists and counsellors in the establishment of a school-based screening program, with specific reference to overcoming perceived barriers.
As the field of Positive Education gains traction globally, there is a recognised concern around sustainability. Many schools utilise external providers to engage and educate schools on ‘wellbeing science’, which in the main is comprised of research from the field of Positive Psychology. This often involves a significant financial and time investment, and while most schools have good intentions for their desired end states, often the initial motivation for change is impacted by the many competing responsibilities occurring within a school setting. Those schools that have successfully implemented strategic and sustainable approaches often continue to work with an external consultant who guides the school to successfully apply their learnings. Many schools, however, are unable to fund ongoing consultancy and are required to utilise their own internal resources. In many cases, this is the inspired and motivated educators who are keen to support the initiative, yet who are generally time-poor, often with other learning and extra-curricular responsibilities. More often than not, the school counsellor has not been consulted or included in these initiatives. We explore the potential role of the school counsellor in providing guidance on the implementation of a Positive Education approach aimed at improving mental health and wellbeing and performance.
The COVID-19 pandemic has exacerbated inequities for people with psychosocial disabilities producing in its wake a serious obstacle for mental health policymakers and advocates committed to upholding Article 12 of the Convention on the Rights of Persons with Disabilities. To overcome this obstacle, stakeholders must resist a common tendency in international mental health policymaking: to over-invest in interventions that arise from a biomedical conception of mental illness. Instead, the pandemic is an opportunity to look beyond the dominant biomedical framework in international mental health care – which has a record of undermining Article 12 principles like legal capacity, autonomy, and self-determination – toward one based on human rights. This shift in positionality will serve to uphold Article 12 and help fulfill the spectrum of human rights for people with psychosocial disabilities.
Unipolar mania is not included in the diagnostic and statistical manual of mental disorders-5 (DSM-5) as a separate diagnosis, although it is defined by widely accepted diagnostic criteria. The aim of this study was to investigate the differences between unipolar mania and bipolar disorder in terms of clinical and inflammatory parameters.
Methods:
The data of 495 hospitalised patients with bipolar disorder diagnoses were analysed retrospectively. Forty met the diagnostic criteria for unipolar mania. Two patients refused to participate in the study. Thirty-eight unipolar mania patients and 42 randomly selected patients with bipolar disorder diagnosis were included in the study. The two groups were compared in terms of sociodemographic, clinical characteristics, serum brain-derived neurotrophic factor, C-reactive protein (CRP), leucocyte and cytokine levels.
Results:
A total of 40 (8.08%) of 495 patients diagnosed with bipolar disorder met the unipolar mania diagnostic criteria. The number of manic episodes and the number of hospitalisations were statistically higher in the unipolar mania group than in the bipolar disorder group. Among all the manic symptoms, the incidence of symptoms such as euphoria, increased sexual interest, grandiosity and delusions were found to be statistically higher in the unipolar mania group. Interleukin (IL)-6 and CRP levels were significantly higher in the unipolar mania group than in the bipolar disorder group.
Conclusion:
Unipolar mania differs from bipolar disorder in terms of clinical features and serum IL-6 and CRP levels.
Anxiety disorders are the most prevalent mental disorder in children and young people. Developing effective therapy for these children is critical to reduce mental disorders across the lifespan. The study aimed to evaluate the efficacy of combining cognitive behavioural therapy (CBT) and sertraline (SERT) in the treatment of anxiety in youth, using a double-blind randomised control trial design.
Methods
Ninety-nine youth (ages 7–15 years) with an anxiety disorder were randomly allocated to either individual (CBT) and SERT or individual CBT and pill placebo and assessed again immediately and 6 months after treatment.
Results
There were no significant differences between conditions in remission of primary anxiety disorder or all anxiety disorders. Furthermore, there were no significant differences in rates of change in diagnostic severity, parent-reported anxiety symptoms, child-reported anxiety symptoms or life interference due to anxiety.
Conclusions
The efficacy of CBT for children and adolescents with anxiety disorders is not significantly enhanced by combination with a short-term course of anti-depressants over and above the combined effects of pill placebo.
To assess the mental health of pregnant women, with reference to anxiety, depression and obsessive-compulsive (OC) symptoms, during the COVID-19 pandemic.
Methods:
A cross-sectional survey was conducted in Ireland during the third wave of the pandemic between February and March 2021. Psychiatric, social and obstetric information was collected from pregnant women in a Dublin maternity hospital, alongside self-reported measures of mental health status.
Results:
Of 392 women responding, 23.7% had anxiety, scoring >9 for GAD-7 (7-item generalised anxiety disorder), 20.4% had depression, scoring >9 for PHQ-9 (9-item depression screening tool: Patient health questionnaire) and 10.3% had obsessive-compulsive disorder (OCD), scoring >13 for Yale–Brown obsessive-compulsive scale symptom checklist (Y-BOCS). Amongst self-reported OCD symptoms, there was a preponderance for obsessions rather than compulsions. Of 392 women, 36.2% described their mental health as worse during the pandemic, most frequently describing symptoms of anxiety and sleep disturbance. When analysed against test scores, self-reported worsening of mental health was significantly associated with higher scores on the GAD-7, PHQ-9 and Y-BOCS scales. The three scores were positively interrelated. Poor mental health scores were associated with self-reported strain in relationship with the baby’s father, and current or previous history of mental illness.
Conclusion:
This study found high levels of depression, anxiety and OC symptoms amongst pregnant women during COVID-19. This highlights the vulnerability of this group to mental illness and the importance of enhanced screening and support during pandemics.
Traumatic brain injury (TBI) is a leading type of epilepsy with significant repercussions for the quality of life of patients, due to the associated injury, consequent epilepsy and cognitive, behavioral or neuropsychiatric sequelae. There have been intense efforts to generate better strategies and methods to treat these patients better. This chapter reviews the advances in animal models of posttraumatic epilepsy (PTE), focusing on rodents, presenting an update on models, their phenotype, findings on neurobiology of TBI and PTE and future directions. The value of models, like the fluid percussion injury, controlled cortical impact, blast, penetrating TBI, weight drop TBI, in this process in being discussed as well as efforts to accelerate progress in the field through the use of collaborative research and infrastructure.
People with psychosis experience cardiometabolic comorbidities, including metabolic syndrome, coronary heart disease and diabetes. These physical comorbidities have been linked to diet, inactivity and the effects of the illness itself, including disorganisation, impairments in global function and amotivation associated with negative symptoms of schizophrenia or co-morbid depression.
Methods
We aimed to describe the dietary intake, physical activity (PA) and sedentary behaviour patterns of a sample of patients with established psychosis participating in the Improving Physical Health and Reducing Substance Use in Severe Mental Illness (IMPaCT) randomised controlled trial, and to explore the relationship between these lifestyle factors and mental health symptomatology.
Results
A majority of participants had poor dietary quality, low in fruit and vegetables and high in discretionary foods. Only 29.3% completed ⩾150 min of moderate and/or vigorous activity per week and 72.2% spent ⩾6 h per day sitting. Cross-sectional associations between negative symptoms, global function, and PA and sedentary behaviour were observed. Additionally, those with more negative symptoms receiving IMPaCT therapy had fewer positive changes in PA from baseline to 12-month follow-up than those with fewer negative symptoms at baseline.
Conclusion
These results highlight the need for the development of multidisciplinary lifestyle and exercise interventions to target eating habits, PA and sedentary behaviour, and the need for further research on how to adapt lifestyle interventions to baseline mental status. Negative symptoms in particular may reduce patient's responses to lifestyle interventions.
The Work and Social Adjustment Scale (WSAS) is an instrument that can be easily applied for routine evaluation of the impact of mental disorders on patient functioning. In spite of the interest in its use, there is very little information available on its psychometric characteristics and even less in Spanish.
Aims:
The objective of this study was to analyse its psychometric characteristics.
Method:
The sample consisted of 441 patients treated in a community mental health unit. They filled out the WSAS and two psychopathology measures, one for anxiety and the other for depression. Fifty-five of them, chosen at random, were asked to fill out the scale again a second time to explore its temporal reliability.
Results:
The scale showed high internal consistency, a single factor that explained 60.4% of the variance, and temporal reliability of .78 for the total score. Significant correlations were found between the WSAS scores and the psychopathological measures, as well as significant differences between those working and those on leave.
Conclusions:
The results confirm the validity and reliability of the scale and support its possible use for routine evaluation of the functional impact of mental disorders.
This chapter explains what avoidant/restrictive food intake disorder (ARFID) is and provides diverse and relatable case examples of each of the three prototypical ARFID presentations, including sensory sensitivity, fear of aversive consequences, and lack of interest in eating or food.
The first edition of Introduction to Psychiatry is a textbook designed to reach medical students, house staff, primary care clinicians, and early-career mental health practitioners. It is the editors’ hope that this text will enable its readers to understand the neuroscientific basis of psychiatry, best practices in the psychiatric assessment and treatment of the patient, the current understanding of core psychiatric diagnoses, and the important underlying issues of population health, public policy, and workforce recruitment and training that must be tackled to bring these advances to all.
Why create a textbook of psychiatry specifically for clinicians not trained for the mental health field? To answer this question, one must understand the troubling challenges facing the mental health workforce, the changing face of mental health care delivery, the enormous comorbidity between psychiatric illnesses and other health conditions, and the impact on non-psychiatric medical illnesses when a comorbid psychiatric disorder is present.
The field of psychopathology is in a transformative phase, and is witnessing a renewed surge of interest in theoretical models of mental disorders. While many interesting proposals are competing for attention in the literature, they tend to focus narrowly on the proximate level of analysis and lack a broader understanding of biological function. In this paper, we present an integrative framework for mental disorders built on concepts from life history theory, and describe a taxonomy of mental disorders based on its principles, the fast–slow–defense model (FSD). The FSD integrates psychopathology with normative individual differences in personality and behavior, and allows researchers to draw principled distinctions between broad clusters of disorders, as well as identify functional subtypes within current diagnostic categories. Simulation work demonstrates that the model can explain the large-scale structure of comorbidity, including the apparent emergence of a general “p factor” of psychopathology. A life history approach also provides novel integrative insights into the role of environmental risk/protective factors and the developmental trajectories of various disorders.
This study examined the relationships between social capital, perceived neighborhood environment, and depressive symptoms among older adults living in rural China, and the moderating effect of self-rated health (SRH) in these relationships.
Participants:
A quota sampling method was applied to recruit 447 participants aged 60 years and older in rural communities in Jilin province, China in 2019.
Measurements:
Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. Structural equation modeling was used to build latent constructs of social capital and test the proposed model. Multiple group analysis was used to test the moderation effects.
Results:
Cognitive social capital and structural social capital were both associated with depressive symptoms controlling for participants’ demographics, socioeconomic status, and health status. After adding perceived environment variables in the model, the relationship between cognitive social capital and depressive symptoms became nonsignificant, while structural social capital remained became a significant factor (β = −.168, p < .01). Satisfaction with health care was significantly associated with depressive symptoms among those with poor SRH (β = −.272, p < .01), whereas satisfaction with security and transportation were strongly associated with depressive symptoms among those with good SRH (security: β = −.148, p < .01; transportation: β = −.174, p < .01).
Conclusions:
Study findings highlighted the importance of social capital and neighborhood environment as potential protective factors of depressive symptoms in later life. Policy and intervention implications were also discussed.
The research domain criteria (RDoC) is an innovative approach designed to explore dimensions of human behavior. The aim of this approach is to move beyond the limits of psychiatric categories in the hope of aligning the identification of psychological health and dysfunction with clinical neuroscience. Despite its contributions to adult psychopathology research, RDoC undervalues ontogenetic development, which circumscribes our understanding of the etiologies, trajectories, and maintaining mechanisms of psychopathology risk. In this paper, we argue that integrating temperament research into the RDoC framework will advance our understanding of the mechanistic origins of psychopathology beginning in infancy. In illustrating this approach, we propose the incorporation of core principles of temperament theories into a new “life span considerations” subsection as one option for infusing development into the RDoC matrix. In doing so, researchers and clinicians may ultimately have the tools necessary to support emotional development and reduce a young child's likelihood of psychological dysfunction beginning in the first years of life.
The quality of life and lifespan are greatly reduced among individuals with mental illness. To improve prognosis, the nascent field of precision psychiatry aims to provide personalised predictions for the course of illness and response to treatment. Unfortunately, the results of precision psychiatry studies are rarely externally validated, almost never implemented in clinical practice, and tend to focus on a few selected outcomes. To overcome these challenges, we have established the PSYchiatric Clinical Outcome Prediction (PSYCOP) cohort, which will form the basis for extensive studies in the upcoming years.
Methods:
PSYCOP is a retrospective cohort study that includes all patients with at least one contact with the psychiatric services of the Central Denmark Region in the period from January 1, 2011, to October 28, 2020 (n = 119 291). All data from the electronic health records (EHR) are included, spanning diagnoses, information on treatments, clinical notes, discharge summaries, laboratory tests, etc. Based on these data, machine learning methods will be used to make prediction models for a range of clinical outcomes, such as diagnostic shifts, treatment response, medical comorbidity, and premature mortality, with an explicit focus on clinical feasibility and implementation.
Discussions:
We expect that studies based on the PSYCOP cohort will advance the field of precision psychiatry through the use of state-of-the-art machine learning methods on a large and representative data set. Implementation of prediction models in clinical psychiatry will likely improve treatment and, hopefully, increase the quality of life and lifespan of those with mental illness.